Friday, July 24, 2009

Is the hospitalist movement going full circle?

The discussion of readmission rates and post-hospitalization care was important, but I was quite disturbed at the murmurs of suggesting that hospitalists now take over some of those outpatient duties post-discharge. Hospitalist medicine emerged because primary care doctors could no longer effectively do clinic AND inpatient medicine. In our community, the primary care doctors that we started admitting for immediately boosted their clinic schedules. And that's fine... unless we can't get your damn inpatients to follow up with you. I think that this is an area where the onus does fall back on the primary care doctors. In our community, they used to be responsible for all the unassigned admissions AND their follow up. I just bristle at the suggestion that the job of the hospitalist needs to start morphing back into the very profession we all found so dissatisfying.

I guess the samelame-brained notion circulating around SHM 2008---that hospitalists are supposed to help fix everything that needs fixing---both in and outside the hospital---was making the rounds again at this year's meeting. The Society of Hospital Medicine is not representing its rank and file members in this important area. Its leadership needs to do a better job of defining and limiting the scope of the hospitalist's job description. There's a lot they could learn from our colleagues in emergency medicine.